Penny-Wise, Billion-Foolish

Pawlenty's plan to slash health and human services only looks good on paper

Back in February, shortly after he had submitted a budget that would hack a billion dollars out of Minnesota's Department of Health and Human Services, Governor Tim Pawlenty let his nice-guy mask slip for a moment and referred to those who would be opposing the cuts as "victims du jour." A month later, a parade of citizens delivered wrenching testimony in front of legislative committees about the chaos and suffering that would ensue as a result of Pawlenty's fiscal priorities, exposing the mean-spirited sense of privilege in the Governor's cavalier comment.

Among those who came to the capitol were three women, each attending to a child in a wheelchair. They spoke with the measured patience, quiet purpose, and attention to detail that comes from long endurance in a tragic situation. One of them, Debbi Harris, lives in Pawlenty's hometown of Eagan. She was accompanied by her chronically ill 10-year-old son Josh, who suffered from a brain hemorrhage at birth, has cerebral palsy, and, as she noted, has had "23 surgeries and countless procedures." When Josh was an infant, Harris, who has a master's in health care administration, quit her career as a technical writer to stay at home and tend to him after an inexperienced home care provider nearly killed him by pouring too much formula down a feeding tube.

Under the terms of Minnesota's Consumer Support Grant program (CSG), which provides families with cash payments so they can manage their child's health care more flexibly, Harris was able to hire a knowledgeable, compassionate woman whose own son had died from conditions very similar to Josh's. (In fact, the state's CSG program allowed Harris to hire this woman despite her lack of certification.) Josh's physician recommends that he receive 16 hours of licensed nursing care a day, but due to changes in the Harris family's insurance and a shortage of nurses, he receives just 16 hours per week. Harris does most of the round-the-clock care herself, tending to him up to 96 hours per week, while still seeing to the needs of her other two children.

The eventual cost of Pawlenty's "savings" will be staggering

Shortly after the terrorist attacks of September 11, Harris's husband Victor, a marine reservist, was called to active duty for Operation Enduring Freedom and had to leave his corporate job. "He is fiercely proud to serve our country and we, his wife and three sons, committed ourselves just as proudly to that sacrifice," Harris testified. Then she added that "Josh's future has become critically uncertain." Under the budget changes Pawlenty is proposing, the family's monthly Medicaid payments would rise from $293 to $796; cuts to the CSG program will also deprive the Harrises of an additional $7,000 a year in funding.

As much as anyone, the Harris family probably qualifies under Pawlenty's definition of "victims du jour"; which is why, after the mother's testimony, the details of their plight were of particular interest to the local media. What is ultimately most poignant about their situation, however, is not its uniqueness, but the relative commonality of their increasing hardship. Under Pawlenty's budget, thousands of Minnesota families will see their Medicaid co-payments skyrocket. The governor has also proposed funding cuts for 200 of the 239 families currently receiving assistance under the CSG program. As Harris and the two women who preceded her made horrifically clear, the program allows dedicated parents to heroically shoulder the burden of tending to their chronically ill children at home, paying themselves and trusted helpers a minimal wage. If Pawlenty's cuts are enacted, they may be forced to look for outside employment and consider funding options that provide more "skilled" nurses and require more frequent institutional care--less quality at greater expense to the state.

According to House testimony by Human Services Commissioner Kevin Goodno, the Pawlenty administration tried to fashion a budget that protected services for the most vulnerable Minnesotans, whom were defined as "children, the disabled, and the frail elderly." But since Pawlenty has stubbornly refused to back down from his campaign pledge not to raise taxes or cut funding for classroom education (which comprises about 40 percent of the overall budget), this show of conservative compassion is simply hollow rhetoric. Listen to hours of testimony and read the fine print of Pawlenty's budget, and it becomes obvious that "vulnerable Minnesotans" will be dramatically affected by cuts in funding and services. As a result, every citizen in the state will suffer from the administration's cost-shifting.

By the state's own calculations, about 68,000 people will lose their health insurance if Pawlenty's budget passes. Simple logic, backed up by a number of studies, indicates that people without insurance rarely pay for preventative programs on their own and generally interact with the health care system only when their maladies have progressed to the point where costly treatments are necessary. "Just maintaining a person's health is important," says Mark Gibson, who as a former policy advisor to Oregon Governor John Kitzhaber was instrumental in establishing a method of determining efficacy and cost-effectiveness in Oregon's seminal state-run health plan. "It gets expensive when a person's health deteriorates, and as people fall in and out of coverage, they lose ground. You look at the data coming out of national studies, it shows that people who are uninsured delay care and diagnosis and suffer both worse outcomes and more severe symptoms as a result of not being covered at that time."